Managed care and emergency medical services: patient knowledge versus patient expectations.
Explore the source record for details and available documents.
Attitude to Health↗
SEARCH · Search PubMed
Results for “Program Acceptability”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
MMR vaccination advice over the Internet.
We wanted to investigate what advice UK homeopaths, chiropractors and general practitioners give on measles, mumps and rubella vaccination programme (MMR) vaccination via the Internet. Online referral directories listing e-mail addresses of UK homeopaths, chiropractors and general practitioners and private websites were visited. All addresses thus located received a letter of a (fictitious) patient asking for advice about the MMR vaccination. After sending a follow-up letter explaining the nature and aim of this project and offering the option of withdrawal, 26% of all respondents withdrew their answers. Homeopaths yielded a final response rate (53%, n = 77) compared to chiropractors (32%, n = 16). GPs unanimously refused to give advice over the Internet. No homeopath and only one chiropractor advised in favour of the MMR vaccination. Two homeopaths and three chiropractors indirectly advised in favour of MMR. More chiropractors than homeopaths displayed a positive attitude towards the MMR vaccination. Some complementary and alternative medicine (CAM) providers have a negative attitude towards immunisation and means of changing this should be considered.
Attitude of Health Personnel↗
Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors.
The association between needle exchange, change in drug use frequency and enrollment and retention in methadone drug treatment was studied in a cohort of Seattle injection drug users (IDUs). Participants included IDUs classified according to whether they had used a needle exchange by study enrollment and during the 12-month follow-up period. The relative risk (RR) and the adjusted RR (ARR) were estimated as measures of the association. It was found that IDUs who had formerly been exchange users were more likely than never-exchangers to report a substantial (> or= 75%) reduction in injection (ARR = 2.85, 95% confidence limit [CL] 1.47-5.51), to stop injecting altogether (ARR = 3.5, 95% CL 2.1-5.9), and to remain in drug treatment. New users of the exchange were five times more likely to enter drug treatment than never-exchangers. We conclude that reduced drug use and increased drug treatment enrollment associated with needle exchange participation may have many public health benefits, including prevention of blood-borne viral transmission.
Adult↗
Diet and exercise in type 2 diabetes mellitus.
The question is no longer whether diet and exercise can benefit the individual with type 2 diabetes. Rather, the type and duration of exercise the magnitude of the effects on glycemic control, insulin sensitivity, and on risk factors for cardiovascular disease must be considered in determining the feasibility and acceptability of an intervention program. It is now clear that regular physical exercise is important in both the prevention and treatment of type 2 diabetes. The benefits of exercise are many and include increased energy expenditure, which, combined with dietary restriction, leads to decreased body fat, increased insulin sensitivity, improved long-term glycemic control, improved lipid profiles, lower blood pressure, and increased cardiovascular fitness. Persons with type 2 diabetes often find it difficult to exercise and are at increased risk for injury or exacerbation of underlying diseases or diabetic complications. Therefore, before starting an exercise program, all patients with type 2 diabetes should have a complete history and physical examination, with particular attention to evaluation of cardiovascular disease, medications that may affect glycemic control during or after exercise, and diabetic complications including retinopathy, nephropathy, and neuropathy. Exercise programs should be designed to start slowly, build up gradually, and emphasize moderately intense exercise performed at least three times a week and preferably five to seven times a week for best results.
Adult↗
NHS patients' perspective on complementary medicine: a survey.
OBJECTIVES: To examine patients' reasons for seeking complementary and alternative medicine (CAM) in the National Health Service, including the nature and duration of the patient's main health problem, the impact of CAM on this, satisfaction with clinical care, and usage of conventional prescription medication. DESIGN: Survey (n=499). SETTING: Out-patient Department, The Royal London Homeopathic Hospital, a National Health Service facility dedicated to CAM. RESULTS: Five hundred and six questionnaires were returned, 499 were analysed. Patients' most frequent reasons for seeking CAM were that other treatment had not helped, and concerns about or experience of adverse treatment reactions. Two hundred and ninety-seven patients (63%) had had their main problem for more than 5 years. Musculoskeletal system problems were the most frequent diagnostic group (n=151, 32%). Satisfaction with clinical care was high (443/490: 90%). Three hundred and eighty patients (81%) indicated their main problem had improved very much, moderately or slightly. Of the 262 patients who had been taking prescription medicines when they first attended, 76 (29%) had stopped, and 84 (32%) had reduced their intake. CONCLUSIONS: The results suggest that orthodox medicine is not meeting the needs of some patients and that CAM may wholly or partly substitute for conventional medicines. Most patients indicated their problem had improved with CAM. Implications for future research are discussed.
Adolescent↗
The Association of Nurses in AIDS Care. Position paper on harm reduction and HIV care for drug users: integrating harm-reduction methods and HIV care.
As the epidemic of HIV disease continues to grow among drug users and their sexual partners, new ways must be adopted to do prevention work, outreach, and service delivery to this population. The Harm Reduction Model offers methods of working with drug users, which are in contrast to traditional methods based on confrontation and that require abstinence before change can occur. This position paper examines the Harm Reduction Model and outlines areas in which the Association of Nurses in AIDS Care can play a role in the expansion of harm-reduction-based intervention and policies.
Attitude of Health Personnel↗
Down syndrome: a review of the literature.
This review of the literature on Down syndrome focuses on various systemic anomalies and oral anomalies, its clinical manifestations, and recommendations for persons with Down syndrome. From the time Down syndrome was diagnosed by phenotype to the present when karyotyping distinguishes chromosomal subgroups, increasingly sophisticated tests and treatments have influenced the lives of Down syndrome patients. Medical advances, special educational programs, and increasing social acceptance of disabled people in the community have resulted in current trends of normalization and deinstitutionalization of these patients. Once a dentist is familiar with a patient's medical history and takes needed precautions, these patients can be treated routinely in a dental office.
Abnormalities, Multiple↗
Health care-seeking practices of pregnant women and the role of the midwife in Cape Town, South Africa.
The objective of this study was to investigate the health-seeking practices of pregnant women in a periurban area in Cape Town, South Africa. This qualitative study was based on 103 minimally structured in-depth interviews of 32 pregnant women. Most women were interviewed on several occasions, and a group discussion was held with women. The interviews were taped, transcribed, analyzed ethnographically, and, if necessary, translated into English. Antenatal care attendance was influenced by a number of factors, including women's knowledge of the role of antenatal care, perceived health needs, booking systems, nurse-patient relationships, economics, child care, and transport. The expected benefits were weighed against the anticipated costs before decisions about seeking care were made. The findings highlight the importance of women's perceptions of quality of care in influencing their health seeking practices. The study suggests that considerably more attention needs to be given to this aspect of maternity services.
Adolescent↗
Predicting contraceptive method usage among women in west Scotland.
Users of the six major methods of contraception are compared across a broad range of variables using data from a community sample. Differences between the groups were apparent for a range of socioeconomic and reproductive variables, and current users of the various methods also differed in their past use of contraception. Users of barrier methods fared particularly well. Few differences were observed for current health status or for the sociocultural variables examined, although users of natural methods differed from all others in their religious affiliation and commitment. Discriminant analysis showed that the most predictive variables distinguishing women who had opted for permanent methods of contraception (female sterilization and vasectomy) were the woman's stated reason for using her current method and her past contraceptive patterns; the inclusion of social, health and reproductive indicators did little to improve the prediction. It is argued that heightened expectations for contraceptive efficacy in the face of increasing concerns about long-term health consequences have contributed to the increased use of permanent methods.
Adult↗
Terrorism in Indonesia.
Indonesia has had its share of natural and manmade disasters. From 1997 to 2002, Indonesia has experienced 90 incidents of terrorist bomb attacks. In 13 (14.4%) of the terrorist attacks, the bombs did not explode. A total of 224 persons have been killed, and 340 persons have been injured. Most of those killed or injured were the result of the bombings in Jakarta and Bali. Besides bombings, there have been riots, especially in Jakarta. The Indonesian Surgeons Association established the 1-1-8 Emergency Ambulance Service Foundation to develop the Prehospital Emergency Medical Services in Indonesia. Despite difficulties, this service has been implemented in 18 cities. The occurrence of disasters, riots, ethnic conflicts, terrorist attacks, and the introduction of the Advanced Trauma Life Support (ATLS) course in 1995, have helped to convince the people and the government that it was important to develop this 1-1-8 Emergency Ambulance Services system, and agreed to accept a Safe Community Program. With the Safe Community Program, Jakarta with its Integrated 1-1-8 Emergency Ambulance Service managed to provide proper emergency medical care to the casualties caused by terrorist bombings, riots, and in the three weeks of floods during which 75% of Jakarta was submerged.
Civil Defense↗
Selected nutritional components and sensory attributes of cowpea (Vigna unguiculata [L.] Walp) leaves.
Reports on the nutritional composition of cowpea leaves have been limited to a small number of lines and the palatability characteristics of leaves apparently have not been studied. This study was therefore undertaken on cowpea leaves to determine the nutrient composition of fifteen varieties and the sensory attributes of ten varieties grown in Ghana. Nutritional components studied were moisture, protein, phosphorus and ascorbic acid. The sensory attributes included leaf size, taste and overall acceptability. There were significant (p > 0.05) differences among varieties in all nutrient components (fresh and dry weight basis), leaf size and overall acceptability. The nutrient composition values, on a dry weight basis, ranged from 9.4 to 13.0% for moisture, 303.8 to 468.9 mg/100 g for phosphorus, 33.5 to 148.0 mg/100 g for ascorbic acid, and 27.1 to 34.7% for protein. Differences in the sensory scores of leaves for taste were not significant (p > 0.05). Overall acceptability positively correlated with leaf size. Moisture content was negatively correlated with overall acceptability, phosphorus and ascorbic acid. Results can be exploited in a breeding program to develop nutritionally superior and acceptable cowpea varieties which can be used for harvesting of both leaves and seeds.
Ascorbic Acid↗
Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation.
STUDY DESIGN: Retrospective study utilising clinical records and public administration databases. OBJECTIVES: This study was performed to analyse the clinical presentation and survival rate of individuals with spinal cord injury (SCI) due to spinal metastasis after primary treatment, and to evaluate the efficacy of rehabilitative efforts. SETTING: Spinal Cord Injury Unit, University Hospital, Heidelberg. METHODS: A total of 68 consecutive patients were included. Demographics, clinical data, tumour type, level and completeness of SCI, initial treatment, functional independence measure (FIM) and survival time were derived from hospital and public administration databases. Cox regression and fuzzy logic rule generation were used for statistical analysis. RESULTS: Of the 68 patients, 66 patients died 11 months (median, interquartile range (IQR) 4-29 months) after the onset of neurological symptoms at an average age of 58 years. The functional independence measure (FIM) score describing the general clinical and functional status proved to be the most reliable prognostic factor of survival. Other more specific parameters (eg tumour type or level of lesion) did not have such an impact. In total, 51 patients completed the rehabilitation programme within 50 days (median, IQR 27-99 days). The FIM score improved from 62 at admission to 84 at discharge. CONCLUSION: The clinical and functional status is a valuable prognostic factor for survival. Since institutionalised rehabilitative efforts are effective, this group of patients should be accepted into such a program.
Adolescent↗
The attendance pattern of clients at a Scottish needle exchange.
AIMS: To examine the pattern of attendance at a Scottish needle exchange. DESIGN: Semi-structured interviews and retrospective analysis of attendance patterns. SETTING: A needle exchange in a Scottish city which covers the whole of the city. PARTICIPANTS: Clients and staff of the needle exchange. MEASUREMENTS: The attendance pattern of 1556 clients of the needle exchange over a 4-year period 1995-1998. FINDINGS: The average frequency of attendance over the 4-year period was 12.7. In 1998, 23% had only visited the needle exchange once and 11% had only visited twice. CONCLUSIONS: A significant minority of clients only attend the needle exchange once or twice a year. There is a need to include information on client retention in future evaluations of needle and syringe exchange clinics and to specify the kind of relationships needle and syringe exchange clinic staff are expected to develop with clients and what level of client retention they should be aiming towards in a well-run clinic.
Adult↗
Educating patients about malignant melanoma: computer-assisted learning in a pigmented lesion clinic.
This prospective controlled study aimed to evaluate the effectiveness and acceptability of a computer program (CAL) designed to educate patients about skin protection including signs of melanoma. Two hundred and twenty-seven patients were recruited either from the Pigmented Lesion Clinic (PLC) or the Orthopaedic Fracture Clinic (OFC). A baseline measure of anxiety was obtained and subjects were allocated to either non-interactive, interactive or control conditions. Measures of anxiety and knowledge about malignant melanoma and skin protection were obtained prior to discharge from the clinic and knowledge was assessed again at 1-week follow-up. Results indicate that, although anxiety in the PLC subjects decreased significantly more than in the OFC patients, there was no significant effect of intervention. There was a significant effect of intervention on knowledge (F = 81.06, d.f. 2, 218, P < 0.0001) with participants having better knowledge on leaving the clinic in the interactive CAL condition than in both the Non-interactive condition and control. Non-interactive CAL was associated with higher knowledge than control. Knowledge gains were maintained at 1-week follow-up.
Adolescent↗
Cultural and noncultural predictors of health outcomes in Korean daughter and daughter-in-law caregivers.
In Western cultures, adverse health effects resulting from providing care for impaired elders is well documented for family caregivers, but little is known about the health of Korean caregivers. This study examined the level of depression and physical health of 120 daughter and daughter-in-law caregivers who cared for cognitively or functionally impaired elderly in Korea. It was hypothesized that cultural factors would have a greater effect on caregivers' health outcomes than noncultural factors, but, contrary to this expectation, the effects of noncultural factors were found to outweigh those of cultural factors. Moreover, the caregivers in this study reported a relatively high level of depression, and more caregivers rated their own health as "poor" than did Western caregivers in previous studies. Family caregiving for the impaired elderly is stressful and negatively affects Korean caregivers' health outcomes regardless of societal values such as filial piety and familism regarding parent care in Korea. Culturally acceptable and sensible support programs may be useful in sustaining long-term care at home by Korean daughter and daughter-in-law caregivers. Further family caregiving studies in the Korean sociocultural context are recommended.
Adult↗
[Complaints and health care system utilisation of ethnic German migrants from the former Soviet Union to Germany and their families].
OBJECTIVES: The aim of the study is the description of subjective morbidity, health care system utilisation and complaints of ethnic German migrants from the former Soviet Union at the beginning of migration. At present no data are available concerning aspects of health behaviour among this largest immigrant population in Germany. METHODS: 300 ethnic German migrants and their families (mean age 37.2 and 51% female) were interrogated shortly after migration to Germany. They answered questions about prevalence of diseases, health care system utilization, actual health status and completed the Giessen Subjective Complaints List (GSCL-24). German standards exist for all questionnaires. RESULTS: 237 ethnic German migrants report to have suffered from at least one disease during the course of the last year. They see the gynaecologist and dentist as often as the German population, pay fewer visits to practitioners and specialists but seek more medical advice from the medical lay system. The majority of subjects are satisfied with their health. Migrants describe their health status as lower than the German population compared to which they also report more complaints (Overall distress in GSCL-24 : 17.2 for migrants and 14.0 for Germans) and different complaints (headaches, fatigue). CONCLUSIONS: The different medical care system and differences in the treatment of patients could account for the less frequent use of medical services by ethnic German migrants. Actual stressors like language differences and acculturation problems are discussed as possible reasons for the increased rate of complaints among ethnic German migrants. Although they suffer from more complaints the German migrants do not seem to modify their help-seeking behaviour.
Acculturation↗
Utilization of 12-step theme groups in a short-term chemical dependence treatment unit.
At Eagleville Hospital, staff have found that utilizing the theme-group process facilitates patient acceptance of 12-Step programs within a relatively short (three weeks) treatment program. Providing a comprehensive orientation to the 12-Step programs increases the likelihood of patients continuing with 12-Step programs as part of their aftercare programs. As previously noted, this is crucial for continued success and sobriety. It is hoped that this description of the use of 12-Step theme groups as part of a comprehensive treatment program will be of help to others.
Hospitals, Psychiatric↗
Hospice and the do-not-resuscitate order.
Recent passage of the Patient Self-Determination Act will require health care providers to develop policies concerning patients' wishes for life prolonging therapy. Since American hospice programs have generally had do-not-resuscitate (DNR) policies since their inception we thought it timely to review the experience of hospice programs with the DNR order. Many programs assume that a signed DNR order is a prerequisite to being accepted as a hospice patient. Other programs are more flexible. This lack of uniformity exposes the unresolved issue within the hospice community as to what is considered appropriate hospice or palliative care. Problems with paramedics responding to 911 calls and not respecting DNR orders or living wills are also discussed.
Advance Directives↗